Provider Demographics
NPI:1083064240
Name:GRINSTEAD, DAWN (CPHT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GRINSTEAD
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 OHIO RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-3257
Mailing Address - Country:US
Mailing Address - Phone:304-675-1612
Mailing Address - Fax:304-675-7338
Practice Address - Street 1:4016 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-3257
Practice Address - Country:US
Practice Address - Phone:304-675-1612
Practice Address - Fax:304-675-7338
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT00001077183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician